Provider Demographics
NPI:1417017690
Name:FLAT ROCK COMMUNITY SERVICES
Entity Type:Organization
Organization Name:FLAT ROCK COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTCEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HULL
Authorized Official - Suffix:
Authorized Official - Credentials:M DIV
Authorized Official - Phone:419-483-7330
Mailing Address - Street 1:7353 COUNTY ROAD 29
Mailing Address - Street 2:PO BOX 1
Mailing Address - City:FLAT ROCK
Mailing Address - State:OH
Mailing Address - Zip Code:44828
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7353 COUNTY ROAD 29
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:OH
Practice Address - Zip Code:44828
Practice Address - Country:US
Practice Address - Phone:419-483-7330
Practice Address - Fax:419-483-5616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7400388Medicaid